Management of Impending Periviable Delivery
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Management of Impending Periviable Delivery Noor Niyar N. Ladhani 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review To review the role of obstetric interventions, the evidence behind these interventions, and the importance of offering these interventions to women and their families as they make decisions on whether to provide active neonatal management. Recent Findings Outcomes for infants born at periviability are improving with advancing neonatal care and management. Obstetric interventions play a role in helping to improve these outcomes. Administration of antenatal corticosteroids and magnesium sulfate should be considered if delivery is suspected. Cesarean delivery should be offered in cases of malpresentation or for other obstetric indications, with appropriate discussion around the associated maternal risks. Delayed cord clamping is considered beneficial and should be applied whenever possible. When active management is considered, or if further discussion is required, transfer to an advanced level NICU should be facilitated if possible. Summary Obstetric management in the setting of an impending periviable delivery can have profound effects on neonatal outcomes. More research into what kind of impact these interventions have on outcomes is necessary. Until then, individualized counseling, shared decision-making, and interdisciplinary involvement are all needed to ensure women and families make as informed a decision as possible. Keywords Periviability . Extreme prematurity . Antenatal corticosteroids . Antenatal counseling . Borderline viability
Introduction As technology advances, the lower limits of viability are shifting, and more women and families are offered full resuscitation of their infant when faced with possible extremely preterm birth. These clinical situations present challenges to the families and care providers involved. In these cases, it is important to present obstetric interventions that may optimize neonatal outcomes, all the while considering the health and values of the mother and her family. These interventions include antenatal transfer to an advanced care center with an appropriate neonatal intensive care unit (NICU), administration of antenatal corticosteroids, magnesium sulfate, and considerations around mode of delivery. Here we describe the evidence and recommendations surrounding several interventions and considerations that may improve outcomes for the extremely preterm infant. These * Noor Niyar N. Ladhani [email protected] 1
Sunnybrook Health Sciences Centre, M4-172 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
cases ultimately require involved, interdisciplinary counseling and shared-decision making to allow for informed choices to be made by women and their families. A periviable birth, or a birth at borderline viability, is any birth before 25 + 6 weeks, but the period of most question regarding intervention is usually less than 24 + 6 weeks. Deliveries may occur due to spontaneous onset of
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